Laser Use Authorization Amendment

Principal Investigator:

(last, first, middle initial)
 LUA Number:
Lab Manager/Contact:

 (last, first, middle initial)

Lab Manager/Contact E-mail (REQUIRED):

 Phone:



Date:
Personnel
NOTE: To add personnel, use a Laser Use Enrollment form*.

To delete personnel, list names below:
  
 

Work Locations
To add locations, list below:
Building Room No. Room Use
To delete locations, list below:
Building Room No. Room Use
Lasers
NOTE: To add lasers, use a Laser Equipment Registration form*.
To delete lasers, list below:
Manufacturer Model Serial Number
To transfer ownership of lasers, list below:
Manufacturer Model Serial Number
Transferred to:
PI Name Building Room No.
Lab Contact Phone No. LUA
Project Summary
To add a new project summary, describe below:
P.I. Sabbatical / Leave of Absence

I will be on sabbatical from:
(START DATE) to (END DATE) .

In my absence, will assume responsibility for laser safety.